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Wednesday, June 15, 2011

Don't Give Up on Women in Medicine

The Mary Elizabeth Garrett Room lies off a busy corridor on the main floor of Johns Hopkins Hospital. As a medical student and later an internal medicine resident at Johns Hopkins, I often treated the small women’s lounge and adjoining locker room as a sanctuary amid my hectic days and nights of studying and call. Its namesake, a philanthropist who was one of the wealthiest women in the US in the late 1800s, used her financial power to provide opportunities for women to gain independence and autonomy. She and her friends offered to raise a badly needed $100,000 for the endowment of the Johns Hopkins School of Medicine if the trustees agreed to admit women on the same basis as men. The rest, for future women in medicine, was history.

In her New York Times opinion-editorial “Don’t Quit This Day Job” (June 12, 2011), anesthesiologist Dr. Karen Sibert argues that women physicians, who increasingly work part-time or leave clinical medicine altogether to find better balance between work and family life, have a moral obligation to practice medicine full-time. She rightly points out that there are limited medical school and residency slots in the face of a growing physician shortage, particularly in the primary care fields that attract women in high numbers. However, Dr. Sibert’s envisioned ideal would be a great loss to patients and the profession, and a major step backwards for women in medicine.

Historically, the practice of medicine had required a selfless devotion to the profession at the cost of personal and family life. Turn of the 19th century legendary physician Sir William Osler is credited for saying, “Medicine is a jealous mistress; she will be satisfied with nothing less.” These roots are evident in the harsh training environment that prevailed for so many years, requiring super-human work hours, rare days off, and expectations to work through personal illness. Slowly, medicine professional culture has made progress, realizing that the care of its members—in all senses of that word—helps physicians (men and women) lead more balanced, healthier, happier lives and helps patients by improving the quality and safety of their healthcare experience through physician work-hours restrictions.

For women physicians, who continue to perform the lion’s share of household duties and child-rearing despite a more progressive society towards the division of household labor, this has meant the increasing availability of part-time positions, job-sharing, and other creative solutions to allow them to continue practicing medicine while fulfilling commitments at home. Achieving work-life balance means greater satisfaction for one’s career and keeps women (and men) physicians in medicine. Indeed, it is this flexibility that is possible in certain specialties such as primary care, dermatology and radiology that makes medicine an attractive career for many women, despite the years of difficult training and medical school debt.

We are, after all, talking about a profession that is built around caregiving, with the parallels between caring for patients and families undeniable. Women physicians spend more time with their patients, up to 10% more, and have been shown to have a distinct style of doctoring from their male counterparts: more encouraging, supportive and patient-centered. The contributions of part-time women physicians are no less in quality to the lives of their patients; shouldn’t such devotion to caregiving at work and home be traits encouraged in physicians?

Invoking the predicted physician work shortage as a reason why women physicians should not work part-time or leave clinical medicine places undue guilt and blame on them. The main factors driving up physician demand is the growth and aging of the US population and health care reform. While women physicians do work fewer patient care hours compared to men, what kind of profession would we have if women who might decide to work part-time later were denied admission? More reasonable (and humane) answers to the physician shortage lies in lifting the residency training caps to train needed physicians and creating new models to increase efficient use of the existing workforce.

Besides, women (and also men), who choose to spend a portion of their medical careers working part-time or who take an extended leave, may return to full-time work at a later time, for example, after their children reach a certain age. Thus, there is a need for effective physician-reentry programs that help prepare any previously trained physician to return to the workforce, providing education and re-training as well as portals to reenter medicine.

Let’s not forget about the men. Besides early to mid-career women, men approaching retirement age are the other fastest growing segment choosing to join the part-time physician workforce. Survey data show that today’s medical students and residents, both men and women, say achieving a balance between their work and professional lives will be the most important factor when establishing a fulfilling career in medicine. Medicine mistresses are going out of style all-around, much to the dismay of the medical henchmen: Burnout, Stress and Dissatisfaction.

To be sure, medicine is a public good. Federal dollars support physician training, and certainly, it is imperative that medical school admissions committees select applicants, male and female, who show a strong commitment to medicine. Yet after training, men as well as women may decide not to practice clinical medicine. Is it more problematic when the reason is because a woman wants to raise a family versus a man who takes a job with a consulting firm? I hope not. These are difficult personal decisions, emphasis on personal. Like everyone else, doctors need to make decisions for the health of themselves and their families. Life happens.

I am a mother, and I am physician. These two roles are complementary in more ways than they are not. The increase in flexibility for women physicians in recent times has been a boon to those of us who have found a calling in medicine but do not want to sacrifice having a full family life. Isn’t that what Mary Elizabeth Garrett had in mind as well? Independence and autonomy for women to practice what they love, to be empowered by having choices.

15 comments:

An excellent response to the article. Thank you for your insights and for sharing such a well written argument for supporting each other in our life choices and needs, Rather than judging and reprimanding our colleagues.

Great post. The Garrett Room is a great symbol for the community of women in medicine, as well as a real place of sanctuary. A fitting beginning for an essay that reminds us of the ideals of independence Garrett advocated. Women need to continue to have more choices, not fewer.

Thanks for writing this, KC. It was an excellent and thoughtful response. The original op-ed was disheartening, but the responses I've read have been extremely encouraging. Yes, those negative attitudes still exist in medicine (and other fields), but it seems that the majority of physicians that I know and respect feel differently and I think that is a good thing. It is always going to be tough to balance a career in medicine and a life outside of it, but I think it is worth the effort and physicians (both men and women) will be better for it.

THANK YOU for writing this, and for giving those of us that are still in the process of becoming a doctor such great encouragement!

That NYT op-ed was utterly ridiculous. It makes me wonder if they posted it simply to draw attention and get more readers - because, in this day and age, no one in their right mind should view women in medicine that way.

Thanks for this post. I'm still upset about the original article - I think its done real damage without an opposing viewpoint published, for no purpose other than to generate publicity. That is not NYT journalism, usually, but i'm not a faithful reader so perhaps i'm wrong about the NYT's usual tenor. I'm still working through my thoughts about the original post. As a primary care physician to largely underserved patients who is part-time clinical because of my public health and policy research responsibilities far more so than my work hours or schedule, I find it utterly reprehensible that an anesthiologist in beverly hills would pass judgment on people practicing part-time clinical medicine as a part of the problem for why we have primary care workforce shortages. Do we really want to debate which of us in medicine are doing more for society or "enough" for society?? Honestly, such a debate has zero appeal for me. as the first LTE notes, we need discussion about the real issues of primary care today, not to put this very important discussion in the light of "mommy wars" and gender issues.

Oh, and while we're at it, let's talk about other professions.Take nursing for example, there is a shortage (at least in our area) and many, many women and men vying to get into nursing school...only to leave when the continual 10 and 12 hour shifts make the profession untenable. One of my personal friends went into Real Estate...

And then there was my Dad who many years ago as a school superintendant was REQUIRED to put in time at not only school board meetings but at the individual meeting of every PTO in the system - and then there were the school choir and band concerts, plays, sporting events. I'm sure that he would have enjoyed spending quality time with the family, but every night after dinner - out he went to do his "duty".

I could go on and on, but I'm sure that everybody gets the picture. We are all in a 24/7 society and as such need to be able to say (firmly) ENOUGH! There are others who need our attention also.

Well said! I hope those of us who strive to strike a balanced life continue to put our voices out there so that we can keep moving in the right direction. To encourage and support physicians and other professionals in demanding careers to seek harmony between their personal and professional lives will only yield positive results in the long term. After all, what is the point of devoting yourself entirely to your practice at the expense of your personal well being?

As a patient, I'd rather have a part-time doc who is 100% invested in my care during that time than a full-time doc who's burned out, uninterested, sleep deprived, or wishing they'd gone into finance. Quality of care is not measured by the hours worked or number of patients seen. It's measured by what is achieved during whatever time is spent.

As a future physician, I thank you for this thoughtful and well written response.

Thank you, KC. I was also disturbed by the article and listened to part of the panel discussion on "On air" (http://onpoint.wbur.org/2011/06/16/should-doctors-work-more). Dr. Sibert kept reiterating her apparent solution, which was that we should think very hard about our commitment before applying to medicine. In her article, she also mentioned that she did not bake cupcakes.

Oh, if only a little meditation on our obligations (wow, medicine devours your life? I had no idea!) and cupcake-omitting would magically generate enough primary care for all. Really, as you said, the problem is a systemic doctor shortage. It's easy and headline-grabbing to blame women for exacerbating the problem instead of looking for a true solution.

I'm not sure there's anything wrong with telling people that they should think hard about their commitment to medicine before applying. It's far too difficult a path to be anything other than fully committed when you start! However, to expect women (or men) to know what they're going to want out of life at age 40 when they are currently 22 seems a bit ridiculous to me. Life happens, priorities change, and nobody should be required to a job they don't want. I want to be a doctor, not a martyr.

I did wonder whether she'd consider my career a cop-out since I have no intention of EVER practicing medicine full time. I want to do research, preferably in academics, but perhaps also in government. I guess Dr. Sibert's philosophy differs from that of the NIH. Too bad for her.

I agree that the problem is systemic. Primary care really ought to pay better than it does.

I am a mother of 3, physician, and wife of physician. I stayed at home (AHHHH) 8 years while my children were young. Could I have predicted this in my training? Never.....I found the experience home with the kids something to be cherished. I resumed work as a pediatric and adolescent gynecologist working part time for a pediatric group in my community. I have volunteered countless hours for many organizations. Has my training been "wasted"? I think the contributions, albeit not direct patient care during those years was valuable to the community and those whose lives I impacted. Was I a different kind of volunteer because I was a physician? YES!!! I think all physicians have to understand work life balance, but of course, if you need to stay late, if you need to follow up, you do it as your moral and professional obligation. Women and men in medicine need to understand the great honor we share with our patients. They invite us into places in their lives that no others are welcome to go. We must never forget this great privilege.

One solution is to be a plant physician. General Motors is one of many companies that hires full time M.D.'s to treat employees. These physicians work eight to five, and may be on call for telephone conversations. The pay is very good for such great hours.How do I know this? I am a telephone counselor, and have several women as clients who are physicians. One of them works at a V.A. hospital, and one of them at an auto manufacturing plant.

(You can leave a message for me on Linked-In or Facebook. Emily Erickson-Sandstrom.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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